The fitness and health of our nation is measured each year by America’s Health Rankings organization. In 2015 Hawaii was ranked as the healthiest state for the fourth time in a row. North Carolina showed the biggest improvement, moving from 37th to 31st.

The study measures a variety of factors, from smoking and obesity to air pollution, infant mortality and infectious diseases.

Where does your state place? The list starts with the best – or healthiest – state.